The usage of proton pump inhibitors : a pharmacoeconomic perspective

Abstract:

Managed health care in South Africa has undergone dramatic changes and restructuring. Managed health care utilizes a variety of organization controls to achieve cost, volume and quality objectives. It can be described as the answer in reaching a cost-effective solution to primary health care, with the promise to bring greater efficacy and cost savings. <br><br> It was found from research in South Africa, that anti-ulcerants took up 16.1% of the world market of products. The management of dyspepsia and duodenal ulcers has been radically altered by the discovery of the role of Helicobacter pylori and the advent of proton pump inhibitors. The use of proton pump inhibitors alone as antisecretory agents and as part of triple therapy regimens for H.pylori accounts for a significant percentage of any health care system's drug budget. <br><br> In the United Kingdom the rapid growth in the use of proton pump inhibitors (PPI) is an overall concern now that restrictions have been placed on the prescribing of these drugs. Their data showed a growth in the PPI market from 50 million pounds in 1992 to 247 million pounds in 1997. <br><br> In South Africa, a developing country, increases in H.pylori incidences can be contributed to the living conditions that are not as sanitary as in developed countries. H.pylori infections in developing countries above the age of twenty is between 75 and100%.<br><br> Managed health care, through the use of pharmacoeconomic studies and drug utiiizatrion reviews, may lower the high costs attributed to proton pump inhibitor usage. <br><br> The general objective of this study was to review and analyze the usage of proton pump inhibitors and the relevance of H.pylori to gastrointestinal diseases in a managed health care system, and to determine the costs and prevalence of H.pylori eradication treatment. <br><br> Non-experimental quantitative research design was employed in this research. Data was obtained from the central database of Interpharm Datasystems&reg; (a managed health care system provider). The sample consisted of all patients that received one or more proton pump inhibitors during the period 1 July 1999 to 30 June 2000. Data were analyzed according to different medicine combinations used simultaneously with proton pump inhibitors (PPIs used alone; PPIs with clarithromycin and amoxicillin; PPIs with amoxicllin and metronidazole, PPIs with tetracycline, metronidazole and bismuth; PPIs with all of the above combinations in simultaneous use of NSAIDs). Descriptive statistics were used to analyze data. Analyses were done by calculating the average mean, the standard deviation, effect sizes and average cost effective ratios. <br><br> It was concluded that the usage of proton pump inhibitors represented 12.4% (N=46646) of the total prescriptions issued during the study period with a cost of R 17,426,608.51. It was also concluded that the group where PPIs were used alone had an 82.57% prevalence if the total PPIs were grouped into sub-groups. Furthermore, the group that included the eradication treatments only resulted into 0.9% of all the PPI containing prescriptions issued. This group was alarmingly small, if taken into account that by introducing eradication treatment ulcers will heal remarkably faster. Comparison of prescribed medicine treatment costs indicated relatively significant differences. Recommendations for further research were formulated. <br><br>